Multivitamins, Multi Questions

By Sally Squires
Washington Post Staff Writer
Tuesday, May 23, 2006

If you're among the majority of Americans who regularly take a multivitamin and mineral pill, last week's conclusion by a federal panel that there's no evidence to recommend for or against these dietary supplements may leave you feeling a bit perplexed.

The report was written by a panel of 13 experts who were convened by the Office of Dietary Supplements and the Office of Medical Applications of Research at the National Institutes of Health to explore questions about patterns of multivitamin use and their effectiveness in a generally healthy population.

Before tossing your multivitamin pills into the trash, here's what you need to know from the 19-page report.

If I eat healthfully, do I need a multivitamin?

It's possible for most people to cover the nutritional bases with food alone, but you'll need to choose very wisely. For example, the 2005 Dietary Guidelines Advisory Committee found that adults and children typically fall short on vitamin E and the minerals calcium, magnesium and potassium. Adults also often don't get enough of vitamins A and C.

What does it take food-wise to meet the recommended intake?

This won't be easy. To start, figure on two cups a day of fruit and about 2 1/2 cups of vegetables, which means at least a serving at every meal plus more for snacks. Variety is essential. Dark leafy vegetables -- especially spinach, kale, chard and mustard greens -- as well as orange vegetables and fruit such as sweet potatoes and cantaloupe are especially important to eat at least two to three times per week. They provide beta carotene, folic acid and many other nutrients. Then you need three servings of whole grains each day. That could be met by eating a cup of oatmeal for breakfast and having a whole wheat sandwich at lunch. Three glasses of nonfat milk (or another calcium- and vitamin-D-fortified substitute, such as orange juice, soy milk, cheese or yogurt) will meet 90 percent of the daily calcium for adults 50 and younger. Nuts and healthy oil, such as olive or canola oil, go a long way toward providing the recommended daily amount of vitamin E.

Can I get eat all that food without going overboard on calories?

That's another challenge. Some scientists think it's tough to get all the nutrients you need from food alone. The guidelines committee did the calculations and found that with diligence it's possible to meet all the recommended intakes and still not overeat, but there are few calories left for splurges on desserts, soft drinks, alcoholic beverages or even a little margarine on your morning toast. How few? Just 181 calories for those who eat 1,800 calories daily -- or about the amount of calories found in one tall skim latte. At 2,000 calories daily, about 200 discretionary calories remain. The good news: If you boost physical activity, you may be able to eat a little more -- emphasis on the "little."

Did the multivitamins panel find that taking the pills can help prevent any chronic diseases?

Yes, but just a few.

ยท The panel underscored the importance of folic acid for all women of childbearing age. This B vitamin has been proven to help reduce the risk of birth defects that cause problems with the spinal cord and nervous system. Since 1998, foods have been fortified with folic acid, and rates of spina bifida and other neural tube birth defects have dropped. Women need 400 micrograms daily of folic acid -- about the amount found in one cup of lentils and one cup of cooked spinach--and also the amount provided by many multivitamins.

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